2006
information
CIRCULAR
TRENDS IN REPORTED FRUIT AND VEGETABLE CONSUMPTION AMONG QUEENSLAND ADULTS: 1995-2004
Torukiri Ibiebele, Terry Coyne, Christine Mc Clintock
Epidemiology Services Unit, Health Information Branch, Public Health Services
Increasing fruit and vegetable consumption is a key public
health priority. Epidemiological studies have shown that
increasing fruit and vegetable intakes decreases the risk
of several major chronic diseases including cancers,
cardiovascular disease, type 2 diabetes and macular
degeneration of the eye. There is little dispute that high
intakes of fruit and vegetables confer significant health
benefits. However, current consumption appears to be
well below the recommended levels in the Queensland
adult population.
Trends in written surveys 1995, 2000 and 2001
Data from the 1995 National Nutrition Survey (1), the
2000 AusDiab Survey (2), the 2001 Omnibus Survey (3),
the 2001 National Health Survey (4) and the most recent
2004 SNAP Survey (5) indicated that there has been an
increase in fruit and vegetable intakes over this time
period. The most recent surveys, however, suggest that,
in general, 90% of adult Queenslanders ate less than the
recommended 5 serves or more of vegetables per day
and approximately half ate less than the recommended 2
serves or more of fruit per day.
Introduction
Key findings
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In 2004, approximately half of Queenslanders
(44% of males and 58% of females) reported
consuming the recommended 2 serves of fruit per
day.
For vegetables, only 10% of adults (9% of males
and 11% of females) reported consuming the
recommended 5 serves or more per day.
In general, while most adults reported NOT
meeting recommendations for intakes of fruit or
vegetables, those at particular risk tended to be:
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Males
Younger age groups
Current smokers
Obese persons
Those at high risk of harm from alcohol in the
short term
Sedentary persons
Reported fruit and vegetable consumption did not
appear to be influenced by level of education or
level of income or SEIFA (area index of socioeconomic advantage/disadvantage).
Trends in reported fruit and vegetable intakes from CATI
surveys, 2001 – 2004
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From 2001 to 2004 the proportion of adults who
reported consuming at least 2 serves of fruit per
day increased by approximately 2% for both
males and females.
Over this same period, the proportion of adults
who reported consuming at least 4 serves of
vegetables per day increased by approximately
12% for males and 8% for females.
Information Circular 74
February 2006
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•
The proportion of adult males and females who
reported consuming the recommended number
of serves of fruit increased by approximately 2%
and 6%, respectively from 1995 to 2001.
For vegetables, the proportion of females who
reported consuming 4 or more serves per day
increased by 14%, whereas for males the increase
was 8%.
There is considerable evidence that diets high in vegetables
and fruit are associated with lower rates of cancers of
most sites (6, 7), lower rates of coronary heart disease (8,
9), stroke (10), hypertension (11), cataracts and macular
degeneration of the eye (12) and type 2 diabetes (13).
Globally, comparative quantification of health risks
showed that a lack of dietary fruit and vegetables
contributes an important share of the world wide burden
of disease. A recent World Health Organization report
(10) estimated that increasing individual fruit and
vegetable consumption up to the theoretical-minimumrisk distribution (600 grams/day for adults) could reduce
the world wide burden of disease for:
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ischaemic heart disease by about 31%,
ischaemic stroke by about 19%,
cancer of the mouth by 19%,
cancer of the oesophagus by 20%,
lung cancer by 12% and,
colorectal cancer by 2%.
The global mortality and morbidity attributable to
inadequate fruit and vegetable consumption was estimated
to be 2.726 million deaths or 26.662 million disability
adjusted life years (DALYs) (10).
The Australian Burden of Disease Study (14) attributes
approximately 11% of all cancers, which relates to 3,000
deaths, to inadequate fruit and vegetable consumption.
According to this Australian study (14), inadequate fruit
and vegetable intake is responsible for around 3% of the
total disease burden, compared to 2% from alcohol and
10% from tobacco.
The importance of nutrition in disease prevention and
health maintenance has been emphasised by publications
of The National Health & Medical Research Council’s
2003 Dietary Guidelines for Australian adults (15), the
Commonwealth Department of Health and Ageing’s
Australian Guide to Healthy Eating 1998 (16), and the
Queensland Public Health Forum’s Eat Well Queensland
(17). All of these publications recommend a minimum
daily intake of two serves of fruit and five serves of
vegetables and legumes for adults aged 19 years and
over as dietary principles to prevent diet-related diseases.
A number of national and state initiatives directed at
1
increasing fruit and vegetable consumption have been
introduced recently.
Therefore there is considerable interest in assessing
changes in fruit and vegetable consumption in the
population. Short dietary questions, which are directed
toward usual intakes, have been used at national and state
levels to assess specific aspects of food intake and food
habits in Australia. These short questions provide data
that give, at minimum cost, a reasonably good indication
of fruit and vegetable intakes. Also, these questions have
been shown to agree well with more detailed methods
of dietary assessment (18, 19), as well as with objective
biomarkers of fruit and vegetable intakes (20).
vegetable question were pre-grouped and one group was
“4 to 5 serves.” Therefore, for the earlier surveys it is not
possible to distinguish between those who consumed 4
serves or those who consumed the recommended 5 serves
or more of vegetables per day. The vegetable question
does not specify whether potato chips are included but if
the respondent asks, the interviewer indicates that chips
can be included.
The 2004 SNAP Survey, however, did record the responses
to the vegetable question as individual serves in whole
numbers (not grouped), making it possible to estimate the
proportion of adults who reported meeting recommended
guidelines for vegetable intake.
This information circular examines trends from 1995
to 2004, in the proportion of Queensland adults who
reported their usual consumption of fruit and vegetables
in surveys using short dietary questions, and further looks
at demography and lifestyle factors associated with fruit
and vegetable intakes.
For all five surveys, sample weights have been applied
to produce representative estimates by age and sex for
the Queensland population. Due to differences in survey
methods and lack of access to the unit record data for
one of the surveys, statistical significance tests were not
performed.
Methods
Results
The data used in this report are based on Queensland data
only, collected from five cross-sectional surveys:
• 1995 National Nutrition Survey (NNS) n= 2396
• 2000 Diabetes, Obesity and Lifestyle (AusDiab)
Survey n=1634
• 2001 National Health Survey (NHS) n=3142
• 2001 Queensland Health (Omnibus) Survey
n=3084
• 2004 SNAP Survey (Smoking, Nutrition, Alcohol
and Physical activity) n=1210.
2004 SNAP Survey
Each survey provided an estimate of the usual number
of serves of fruit and vegetables consumed per day using
standard short questions. The 1995 NNS, the 2001 NHS,
and 2000 AusDiab were national surveys and used selfcompleted written questionnaires, while the 2001 Omnibus
survey and the 2004 SNAP survey used the Computer
Assisted Telephone Interview (CATI) method. Owing to
the different data collection methods used, the written
surveys and the CATI surveys are presented separately.
Gender
Overall, women reported eating more fruit and vegetables
than men, although both reported consuming less than
the recommended number of serves per day. Figure 1
indicates that approximately 58% of Queensland females
and 44% of males reported usually consuming the
recommended 2 serves or more of fruit a day. Yet, about
14% of females and 20% of males and females reported
eating less than 1 serve per day or not usually consuming
any fruit.
Figure 1. Reported usual daily intake of FRUIT for
Queensland adults by gender - using SNAPS 2004 data
Survey participants 18 years of age and over (25 years and
over in AusDiab) were asked to respond to the following
questions:
•
•
“How many serves of fruit do you usually eat each
day?
including fresh, frozen or tinned fruit. A serve =
1 medium piece or 2 small pieces of fruit or 1 cup
of diced pieces of fruit.”
“How many serves of vegetables do you usually
eat each day?
including fresh, frozen or tinned vegetables. A
serve = ½ cup cooked vegetables or 1 cup of salad
vegetables.”
The question related to fruit intake does not specify that it
does not include juice, but if the respondent asks about fruit
juice, the interviewer indicates that juice is not included.
Although the Dietary Guidelines for Australians Adults’
(15) recommendation is for at least 5 serves of vegetables,
the possible responses in the surveys up to 2004 to the
2
For vegetables however, only 10% of Queenslanders (about
9% of males and 11% of females) reported consuming
the recommended 5 serves or more of vegetables a day
(Figure 2). Most adults reported consuming 1 to 2 serves
of vegetables. Less than 6% of the population reported
not consuming vegetables at all or less than 1 serve per
day.
Figure 2. Reported usual daily intake of VEGETABLES for
Queensland adults by gender - using SNAPS 2004 data
Figure 5. Reported usual daily intake of FRUIT
Queensland adults by smoking status - using SNAPS
2004 data
Age groups
The reported patterns of usual daily fruit intake by age
showed that one fourth of young adults aged 18 to 24
reported not consuming any fruit or less than 1 serve per
day (Figure 3). In general, the proportion who reported
consuming 2 serves or more increased with age.
Figure 3. Reported usual daily intake of FRUIT for
Queensland adults by age group - using SNAPS 2004
data
Although the pattern was similar for reported daily
vegetable consumption, almost 10% of the young adults
aged 18 to 24 years reported usually consuming no
vegetables or less than 1 serve a day (Figure 4). Again,
those who reported consuming the recommended 5 serves
per day tended to increase with age.
Figure 4. Reported usual daily intake of VEGETABLES for
Queensland adults by age group - using SNAPS 2004
data
Lifestyle characteristics
Smoking Status
Figure 5 indicates that current smokers were much more
likely than non-smokers to not eat fruit or to eat less than
one serve per day (28% vs 13% respectively).
Information Circular 74
Current smokers reported a similar pattern regarding
usual daily vegetable intake. Figure 6 illustrates that
current smokers were more likely than non-smokers to
report consuming no vegetables or less than one serve
per day (11% vs 4%), and were also less likely to report
consuming the recommended five serves or more of
vegetables compared with non-smokers (7% vs 11%).
Figure 6. Reported usual daily intake of VEGETABLES for
Queensland by smoking status - using SNAPS 2004 data
Body Mass Index
In the 2004 SNAPS, the proportion of Queensland adults
who reported usually consuming the recommended two
or more serves of fruit per day decreased with increasing
BMI although this did not appear to be significant (Figure
7).
Figure 7. Reported usual daily intake of FRUIT for
Queensland adults by BMI categories - using SNAPS
2004 data
The converse was true for reported vegetable intake. The
proportion of Queenslanders consuming the recommended
five or more serves of vegetables increased with increasing
BMI status; lower for those considered underweight (3%)
3
compared with those in the normal, overweight and obese
categories (approximately 11%, 9% and 11%, respectively;
Figure 8).
Figure 8. Reported usual daily intake of VEGETABLES
for Queensland adults by BMI categories - using SNAPS
2004 data
Physical activity
Data on reported physical activity and usual daily fruit
and vegetable consumption were available from the 2001
NHS. Figures 11 and 12 show that, overall, adults who
were sedentary were less likely to report consuming the
recommended two or more serves of fruit than were those
who engaged in light, moderate or vigorous levels of
physical activity. There were only slight differences in
the proportion of adults who reported consuming four or
more serves of vegetables by activity level.
The data for vegetable intake for these surveys was only
recorded as 4 – 5 serves grouped together, and thus is
presented as 4 serves or more.
Alcohol consumption
Figure 11. Proportion of Queensland adults who
reported usually consuming 2 or more serves of FRUIT
per day, by physical activity level using NHS 2001 data
Figure 9 illustrates that those with a high risk of harm
from alcohol in the short term were three times more
likely than non-drinkers to report that they eat no fruit
or less than 1 serve per day and were much less likely to
report eating two or more serves of fruit per day (18% vs
57%) compared with non-drinkers.
Figure 9. Reported usual daily intake of FRUIT for
Queensland adults by reported alcohol consumption using SNAPS 2004 data
Figure 12. Proportion of Queensland adults who
reported usually consuming 4 or more serves of
VEGETABLES per day, by physical activity level using
NHS 2001 data
The pattern was similar for high risk drinkers compared
to non-drinkers or low-risk drinkers regarding reported
vegetable intake. Figure 10 indicates that those with a
high risk of harm from alcohol in the short term were
more likely than non-drinkers to not eat vegetables or eat
less than one serve per day (18 vs 6%).
Figure 10. Reported usual daily intake of VEGETABLES
for Queensland adults by reported risk of harm from
alcohol consumption in the short term -using SNAPS
2004 data
Income
Data on fruit and vegetable intakes by income and
educational level were available from the 1995 NNS, the
2000 AusDiab, and the 2001 NHS. Figure 13 suggests that
in all three surveys, income had little effect on reported
fruit consumption.
4
Figure 13. Proportion of Queensland adults who
reported usually consuming 2 or more serves of FRUIT
per day, by income category, 1995 to 2001
Queensland adults with secondary education or less were
just as likely as those with post secondary education to
report consuming 2 or more serves of fruit and 4 or more
serves of vegetables.
Figure 16. Proportion of Queensland adults who
reported usually consuming 4 or more serves of
VEGETABLES per day, by education level, 1995 to 2001
Although vegetable consumption was expected to increase
as income level increased, as reported by some authors
(22), this pattern was generally not observed in these
surveys. Income appeared to have little effect on reported
usual daily vegetable consumption (Figure 14).
Figure 14. Proportion of Queensland adults who
reported usually consuming 4 or more serves of
VEGETABLES per day, by income category, 1995 to 2001
Socio-Economic Index For Areas (SEIFA)
SEIFA is a tool that enables the investigation of the socioeconomic well-being of Australian communities, and
identifies areas of advantage and disadvantage. Data
from the 2001 NHS (Figure 17) suggest that more adults
from the most disadvantaged areas reported consuming
at least 2 serves of fruit, but there appeared to be little
effect of SEIFA levels on the proportion of Queensland
adults who reported 4 or more serves of vegetables per
day.
Figure 17. Proportion of Queensland adults who reported
usually consuming 2 or more serves of FRUIT per day,
or 4 or more serves of VEGETABLES per day, by SEIFA
quintile, using NHS 2001 data
Education
Also in these three surveys, the proportion of adults who
reported consuming 2 or more serves of fruit, or 4 or
more serves of vegetables, did not appear to differ with
educational level (Figures 15 and 16).
Figure 15. Proportion of Queensland adults who
reported usually consuming 2 or more serves of FRUIT
per day, by education level, 1995 to 2001
Information Circular 74
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Trends in fruit and vegetable intakes using CATI
survey data
Data from the 2001 and 2004 CATI surveys suggest
that there was a slight (2%) increase in the proportion
of both males and females who reported consuming the
recommended number of servings of fruit per day (Figure
18).
Figure 20. Proportion of adult Queenslanders who
reported consuming 2 or more serves of fruit per day, by
sex, 1995 to 2001
Figure 18. Proportion of Queensland adults who
reported consuming the recommended two serves of
FRUIT per day using 2001 and 2004 CATI survey data
Figure 21 suggests that the proportion of adults who
reported consuming 4 serves or more of vegetables
increased overall by about 11% (8% among males and
14% of females).
Trends in vegetable consumption over this time period
showed a greater increase of 12% for males and 8% for
females consuming 4 or more serves per day (Figure 19).
Vegetable consumption for these comparisons is based on
4 serves or more per day, not the recommended 5 serves
or more per day.
Figure 21 suggests that the proportion of adults who
reported consuming 4 serves or more of vegetables
increased overall by about 11% (8% among males and
14% of females).
Figure 19. Proportion of adult Queenslanders who
reported consuming 4 or more serves of VEGETABLES
per day, using 2001 and 2004 CATI survey data
These data suggest that there is some agreement between
the CATI surveys and written surveys, and that there was
a slight increase in the proportion of adults consuming
the recommended serves of fruit per day and around a
10% increase in the proportion of adults who consumed
at least 4 serves of vegetables per day.
Conclusion
Trends in fruit and vegetable intakes using written
survey data
Reported fruit and vegetable consumption data is available
from the 1995 NNS, the 2000 AusDiab and the 2001 NHS,
and show a similar trend to the CATI surveys. The trends
from 1995 to 2001 indicate an overall increase of about
4% in proportions of adults (2% in males and 6% among
females) who consumed the recommended two serves of
fruit per day (Figure 20).
6
Although there appears to have been a slight increase in
the proportion of Queensland adults reporting meeting
recommended intakes of fruit and 4 serves or more of
vegetables between 1995 and 2004, the proportion of
adults meeting recommended intakes is still alarmingly
low. In general, more females than males reported better
intakes at all ages with the lowest proportion of adults
reporting recommended intakes in the younger age
groups.
As with many types of health monitoring endeavours,
methodological issues are important here. While all of
the surveys used exactly the same questions related to
fruit and vegetable intakes, the methods of administering
the questionnaires were different. The national surveys;
the 1995 NNS and the 2001 NHS, and the AusDiab were
self-completed written questionnaires, whereas the 2001
Omnibus and the 2004 SNAP Survey were telephone
interviewed. It is possible that telephone interviews
provided more reliable estimates than self-completed
questionnaires. Also, the representativeness of the surveys
may have differed. The large national surveys and the two
CATI surveys are considered to be quite representative of
the Queensland population, whereas in the AusDiab study,
there was a low response rate and also some evidence
that the cohort may have been of slightly higher socioeconomic status and more health conscious (23).
There are also acknowledged difficulties encountered
in collecting dietary data. Respondents may under
report or over report intake, depending on their level
of knowledge about recommendations or their desire to
please the interviewer. Respondents may have difficulty
in estimating usual intakes, or be unable to accurately
remember usual intake. Estimating portion sizes is also a
challenge for some survey participants.
These data support the need for continued campaigns aimed
at increasing the consumption of fruit and vegetables and
the need to target younger age groups, particularly males.
These data also indicate the importance of continuing
to monitor fruit and vegetable intakes. These relatively
simple questions have been shown to be useful tools to
do this (20).
References
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2 Dunstan D, Zimmet P, Welborn T, Sicree R, Armstrong T,
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Diabetes Institute; 2001.
3 Epidemiology Services Unit. Omnibus 2001 Survey. Brisbane:
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9 Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett
WC, et al. Fruit and vegetable intake and risk of cardiovascular
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